What can we do to preserve the peritoneum?

Area of Science:

• Nephrology
• Biomaterials Science
• Cell Biology

Background:

• Long-term peritoneal dialysis (PD) can cause peritoneal membrane failure, characterized by ultrafiltration loss.
• This failure is linked to increased peritoneal blood vessels, fibrosis, and mesothelial cell loss.
• Bioincompatible dialysis solutions are implicated in the pathogenesis of these peritoneal alterations.

Purpose of the Study:

• To review the toxicity of dialysate constituents.
• To assess current interventions for preserving the peritoneum.
• To evaluate the outcomes of these interventions.

Main Methods:

• Review of literature on dialysate toxicity and peritoneal preservation interventions.
• Analysis of experimental and clinical studies on dialysis solutions and their effects on the peritoneum.
• Assessment of animal models and human studies on peritoneal transport and effluent markers.

Main Results:

• Glucose, lactate, and glucose degradation products (GDPs) are key toxic dialysate components.
• Vascular Endothelial Growth Factor (VEGF) likely mediates diabetiform peritoneal neoangiogenesis, influenced by glucose and lactate.
• Interventions like using amino acid-based or icodextrin-based dialysates, bicarbonate buffers, and low-GDP solutions show potential benefits, including increased CA125 levels and reduced neovascularization in animal models.

Conclusions:

• Strategies to preserve the peritoneum focus on minimizing exposure to bioincompatible solutions.
• Currently available biocompatible dialysis fluids offer potential benefits.
• Further research is needed to develop novel dialysis solutions with improved biocompatibility, utilizing alternative osmotic agents and buffers.